The NHS has used hi fidelity patient simulation for high pressure clinical scenarios for many years, where either actors or sophisticated dummies act as patients and scenarios are played out and recorded. This gives NHS staff a learning environment that is safe and controlled so that the participants are able to make mistakes, correct those mistakes in real time and learn from them, without fear of compromising patient safety. It also allows for changes in process and workflows to be identified and tested, to improve ways of working.

Simulation labs are well evidenced and used in contexts such as medical training (for example crash calls or trauma) but their application in a digital health context has not previously been systematically researched and tested in the UK. Given the abundance of new technology that NHS teams are now using, ranging from apps to new handheld devices to multi-million pound electronic record systems and equipment, this project aims to test the benefits of simulation for digital health.

At its most basic, simulation requires a screen and camera set-up, typically with cameras in the room that can show the action in real time. The simulation can use a mix of clinicians, staff and actors. Recording the action is crucial so that reflection and learning can take place effectively.

This project aims to show that simulation can be done in a cost effective, mobile way. For example, it will explore whether Trusts could create their own simulations by putting their own screens up and using in-house cameras and laptops at relatively low cost. If this is achieved it could help the NHS make better technology procurement decisions, help staff feel confident in stressful scenarios that involve multiple combinations of technologies and identify design improvements more quickly.

Technology simulation is the norm in many industries. NASA simulates its technology in the closest possible conditions to space using a neutral buoyancy lab. In healthcare, many American hospitals simulate technology on a regular basis. By contrast, while the NHS uses simulation for many traditional clinical scenarios it rarely tests new technologies in a genuinely live environment before they are procured.

The NHS invests millions in new technology every year. Roll outs of technology are complex and it can take many years for the full benefits of new technology to be realised. User testing of digital technologies at the development stage often take place separate to the clinical setting because tech companies struggle to access real-world practice settings as a result of governance, safety and capacity in teams. As a result it is not possible to identify, mitigate and manage problems faced by real users in the context of clinical care.

The team will be focusing on mental health contexts and will start with digital apps, aiming to create a simulation environment that is mobile so it can be easily repeated by other trusts without the need for an expensive standalone simulation lab. The pilot simulation model will be developed drawing on simulation theory and research, user-centred design, agile and implementation methodologies and technology engineering. The final result from this pilot project will be a powerful resource that supports adoption of digital technologies in practice and promotes a technology simulation culture within the NHS.

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